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Background <p>Respiratory viral infections are a leading cause of hospitalization in children &lt; 5 years. Understanding viral circulation, co-infections, and disease severity is essential for prevention and clinical management.</p> Methods <p>This retrospective, single-center observational study was conducted between September 2023 and April 2025, and was based on multiplex PCR viral panel results obtained from respiratory samples of children under 5 years of age referred to IRCCS Policlinico. Repeated respiratory samples from the same patient yielding identical results were considered a single episode. When multiple samples collected &lt; 7 days apart showed alternating positive and negative results, only the first positive sample was considered. Descriptive statistics and Fisher’s exact test evaluated episode characteristics, virus circulation, and co-infections. Logistic regression analysis identified factors associated with pediatric high-dependency ward or intensive care unit admission.</p> Results <p>A total of 2,512 respiratory episodes in 2,239 patients were analyzed; 1,405 (55.9%) occurred in male patients, with a median(IQR) age of 1.03 (0.26–2.17) years. Pediatric high-dependency ward admission and intensive care unit admissions were reported in 432 (21.7%) and 103 (5.2%) of 1990 episodes with available clinical data, respectively. Human rhinovirus (HRV, 31.4%) was the most frequently detected pathogen, followed by RSV-A/B (13.9%). Co-infections were detected in 598 (37.6%) samples, most commonly HRV plus enterovirus (21.4%). Compared with 2023/2024, the 2024/2025 season showed reduced circulation of RSV (18.4% vs. 13.9%, <i>P</i> = 0.006) and human metapneumovirus (MPV; 8.9% vs. 5.5%, <i>P</i> = 0.002), alongside increased influenza A/B (7.4% vs. 11.8%, <i>P</i> = 0.0005). Logistic regression analysis revealed that pediatric high-dependency ward or intensive care unit admission was positively associated with lower respiratory tract symptoms and with the detection of RSV A/B, HRV, MPV, human enterovirus, human parainfluenza virus, and adenovirus (<i>P</i> &lt; 0.05).</p> Conclusion <p>Respiratory viruses remained prevalent among symptomatic children &lt; 5 years, with HRV predominating across seasons. A reduction in RSV circulation was observed in 2024/2025, temporally coinciding with nirsevimab introduction, even though no direct attribution can be made in the absence of individual-level immunization data. Overall, these findings support continued hospital-based virological surveillance in young children to monitor changes in viral circulation and clinical burden.</p>

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Respiratory viral infections in children under five during two consecutive autumn–winter seasons

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月30日

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  • Niloofar Hejazifar,
  • Patrizia Bono,
  • Alessandra Parisi,
  • Marco Caruso,
  • Federica Giorgetti,
  • Giada Maria Di Pietro,
  • Andrea Lombardi,
  • Carlo Pietrasanta,
  • Monica Spolti,
  • Giampaolo Portella,
  • Gianluigi Galli,
  • Claudia Tagliabue,
  • Antonio Muscatello,
  • Giovanna Chidini,
  • Monica Fumagalli,
  • Filippo Salvini,
  • Samantha Bosis,
  • Alessandra Bandera,
  • Annapaola Callegaro,
  • Claudia Alteri

摘要

Background

Respiratory viral infections are a leading cause of hospitalization in children < 5 years. Understanding viral circulation, co-infections, and disease severity is essential for prevention and clinical management.

Methods

This retrospective, single-center observational study was conducted between September 2023 and April 2025, and was based on multiplex PCR viral panel results obtained from respiratory samples of children under 5 years of age referred to IRCCS Policlinico. Repeated respiratory samples from the same patient yielding identical results were considered a single episode. When multiple samples collected < 7 days apart showed alternating positive and negative results, only the first positive sample was considered. Descriptive statistics and Fisher’s exact test evaluated episode characteristics, virus circulation, and co-infections. Logistic regression analysis identified factors associated with pediatric high-dependency ward or intensive care unit admission.

Results

A total of 2,512 respiratory episodes in 2,239 patients were analyzed; 1,405 (55.9%) occurred in male patients, with a median(IQR) age of 1.03 (0.26–2.17) years. Pediatric high-dependency ward admission and intensive care unit admissions were reported in 432 (21.7%) and 103 (5.2%) of 1990 episodes with available clinical data, respectively. Human rhinovirus (HRV, 31.4%) was the most frequently detected pathogen, followed by RSV-A/B (13.9%). Co-infections were detected in 598 (37.6%) samples, most commonly HRV plus enterovirus (21.4%). Compared with 2023/2024, the 2024/2025 season showed reduced circulation of RSV (18.4% vs. 13.9%, P = 0.006) and human metapneumovirus (MPV; 8.9% vs. 5.5%, P = 0.002), alongside increased influenza A/B (7.4% vs. 11.8%, P = 0.0005). Logistic regression analysis revealed that pediatric high-dependency ward or intensive care unit admission was positively associated with lower respiratory tract symptoms and with the detection of RSV A/B, HRV, MPV, human enterovirus, human parainfluenza virus, and adenovirus (P < 0.05).

Conclusion

Respiratory viruses remained prevalent among symptomatic children < 5 years, with HRV predominating across seasons. A reduction in RSV circulation was observed in 2024/2025, temporally coinciding with nirsevimab introduction, even though no direct attribution can be made in the absence of individual-level immunization data. Overall, these findings support continued hospital-based virological surveillance in young children to monitor changes in viral circulation and clinical burden.